Healthcare Provider Details

I. General information

NPI: 1629528682
Provider Name (Legal Business Name): NEWHIDE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 SAN BERNARDINO ST SUITE 102
MONTCLAIR CA
91763-2328
US

IV. Provider business mailing address

4950 SAN BERNARDINO ST SUITE 102
MONTCLAIR CA
91763-2328
US

V. Phone/Fax

Practice location:
  • Phone: 951-314-2255
  • Fax:
Mailing address:
  • Phone: 951-314-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SUHA RAYYIS NEWHIDE
Title or Position: PRESIDENT
Credential: MD
Phone: 951-314-2255